It has recently been suggested that some forty to fifty percent of the population over age fifty years experience a sleep disorder breathing. About five percent of the general adult population, and ten percent of men over the age of forty years, may have clinically important sleep apnea. This is now recognized as a cause of considerable morbidity and, potentially, sudden death.
Such sleep disorder breathing frequently goes undiagnosed. The most common symptom presented is excessive daytime sleepiness, and such symptoms and behavioral patterns are often overlooked or considered as normal sequela of aging.
In addition, disordered sleep of the institutionalized elderly is often treated with strong drug therapy, including the administration of hypnotics and sedatives. These drugs are frequently used because disordered sleep may produce sleep onset insomnia or frequent early morning arousals with resulting poor sleep maintenance. Paradoxically, this drug treatment worsens the quality of sleep and increases the risk of obstructive apnea. This initiates a vicious cycle in which further deterioration of sleep results in increased use of the drugs until such heavy sedation occurs that confusion or dementia results.
Where sleep apnea has been properly diagnosed, surgery has been considered the only reliable treatment, with tracheostomy being the surgical intervention against which other treatments are measured.
Some attempts have been made to create noninvasive devices for reducing apnea. One such is the "equalizer" a commercially designed and available mouth insert having tubes extending outward between the lips, claimed to reduce air pressure from the nasal passages.
This device is an embodiment of U.S. Pat. No. 4,553,549 to Pope and Hawkins (the applicant here) which discloses an oral appliance for maintaining mandible in a neuromuscularly balanced rest position, together with tubes for providing equalization of air pressure from within the oralpharyngeal cavity to the outside air.
The standard treatments for Sleep Disorders in the Elderly remains as described in Michael G. Moran, M.D., et al, "Sleep Disorders in the Elderly", American Journal of Psychiatry 145, Nov. 11, 1988.